Which plain radiographic finding best distinguishes caecal volvulus from sigmoid volvulus?

• A Gas confined to the left colon with a cut-off at the splenic flexure
• B A coffee bean shaped loop arising from the pelvis with its apex pointing to the right upper quadrant
• C Multiple centrally placed dilated loops with valvulae conniventes crossing the full width of the lumen
• D A hugely dilated caecal loop displaced toward the epigastrium or left upper quadrant with its concavity facing downward and to the left ✓

Explanation

In caecal volvulus the twisted caecum flips upward and medially, appearing as a single large ovoid gas-filled loop in the epigastrium or left upper quadrant, classically described as kidney bean or comma shaped, often with a single fluid level and dilated small bowel below it. Option B describes sigmoid volvulus, whose loop originates in the pelvis and points its apex toward the right upper quadrant. Options C and A describe small bowel obstruction and large bowel obstruction from a distal lesion, neither specific to volvulus.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.